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Urbanek L, Schaack D, Bordignon S, Tohoku S, Hirokami J, Plank K, Koch A, Chun KRJ, Schmidt B. Ventricular tachycardia due to left ventricular metastasis: A case report. J Electrocardiol 2024; 85:37-38. [PMID: 38830293 DOI: 10.1016/j.jelectrocard.2024.05.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
We present the case of a 60-year-old male patient who was admitted to our hospital after experiencing a syncopal episode. First ECGs showed sinus rhythm with polymorphic premature ventricular complexes and later ventricular tachycardia with a left bundle branch block morphology were recorded. Imaging with TEE and MRI revealed a space-occupying lesion in the left ventricle, which was ultimately identified as a rare cardiac metastasis of renal cell carcinoma. Treatment was initiated with monoclonal antibodies resulting in lesion regression. This case highlights the importance of comprehensive diagnostic in patients with history of malignancy.
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Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany.
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Alexander Koch
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein- Str. 4, 60431 Frankfurt/M, Germany.
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2
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Ali A, Shah S, Furrukh M. Renal Cell Carcinoma Metastasis to the Left Atrium. Tex Heart Inst J 2022; 49:482661. [PMID: 35675083 DOI: 10.14503/thij-20-7452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Only 13 cases of renal cell carcinoma metastasis to the left atrium of the heart have been described. We report the case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at our neurology department in 2020. Magnetic resonance images of the brain showed metastatic lesions; subsequent computed tomograms of the chest, abdomen, and pelvis revealed a mass in the left atrium and multiple metastases in the lung, pleura, and pancreas. Our cardiologists advised against surgical removal of the left atrial mass because of a poor prognosis, so radiation therapy and immunotherapy were initiated instead.
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Affiliation(s)
- Aizaz Ali
- Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan
| | - Saeedullah Shah
- Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Furrukh
- Department of Clinical Oncology, Shifa International Hospital, Islamabad, Pakistan
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Helman T, Imam A, Espino-Grosso P, Patel T. Upper tract urothelial carcinoma with Oligometastasis to the right ventricle, surgical considerations, and management. Urol Ann 2022; 14:89-92. [PMID: 35197710 PMCID: PMC8815341 DOI: 10.4103/ua.ua_157_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Right ventricular (RV) metastasis from an upper tract urothelial carcinoma without inferior vena cava or right atrial involvement is an extremely rare event which highlights the heterogeneity of this disease process. We report a case of a 43-year-old man presenting for long-standing hematuria and left flank pain. Computed tomography revealed a left renal mass with para-aortic lymphadenopathy, in addition to a potential mass in the RV. The mass involving the RV was confirmed on subsequent cardiac evaluation with magnetic resonance imaging (MRI) and echocardiography. After discussion in a multidisciplinary tumor board, the patient underwent a left nephrectomy, regional lymphadenectomy, and excision of metastatic RV tumor with bovine patch reconstruction. Final pathology reported invasive urothelial carcinoma in the left kidney with involvement of regional para-aortic lymph nodes and metastatic tumor in the RV (T4N3M1, AJCC 8th edition). The patient did well postoperatively and completed adjuvant Cisplatin-Gemcitabine systemic chemotherapy. This is an important addition to the literature as it highlights the aggressive and heterogeneous nature of urothelial carcinoma and the utility of cardiac MRI in surgical planning.
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Rupal A, Jani C, Singh H, Khanna P, Patel D, Perry J, Jain A, Arora S, Elfiky A. Late metastatic recurrence of renal cell carcinoma in the heart and mediastinum: A case report and review of literature. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cao J, Yang Y. 18F-FDG PET/CT detected recurrent renal cell carcinoma presenting with cardiac metastasis. J Nucl Cardiol 2021; 28:3085-3087. [PMID: 33977368 DOI: 10.1007/s12350-021-02652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jiahua Cao
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yuhua Yang
- Department of PET/CT, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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Quagliariello V, Berretta M, Buccolo S, Iovine M, Paccone A, Cavalcanti E, Taibi R, Montopoli M, Botti G, Maurea N. Polydatin Reduces Cardiotoxicity and Enhances the Anticancer Effects of Sunitinib by Decreasing Pro-Oxidative Stress, Pro-Inflammatory Cytokines, and NLRP3 Inflammasome Expression. Front Oncol 2021; 11:680758. [PMID: 34178667 PMCID: PMC8226180 DOI: 10.3389/fonc.2021.680758] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/21/2021] [Indexed: 01/18/2023] Open
Abstract
Renal cell carcinoma (RCC) represents the main renal tumors and are highly metastatic. Sunitinib, a recently-approved, multi-targeted Tyrosine Kinases Inhibitor (TKi), prolongs survival in patients with metastatic renal cell carcinoma and gastrointestinal stromal tumors, however a dose related cardiotoxicity was well described. Polydatin (3,4’,5-trihydroxystilbene-3-β-d-glucoside) is a monocrystalline compound isolated from Polygonum cuspidatum with consolidated anti-oxidant and anti-inflammatory properties, however no studies investigated on its putative cardioprotective and chemosensitizing properties during incubation with sunitinib. We investigated on the effects of polydatin on the oxidative stress, NLRP3 inflammasome and Myd88 expression, highlighting on the production of cytokines and chemokines (IL-1β, IL-6, IL-8, CXCL-12 and TGF-β) during treatment with sunitinib. Exposure of cardiomyocytes and cardiomyoblasts (AC-16 and H9C2 cell lines) and human renal adenocarcinoma cells (769‐P and A498) to polydatin combined to plasma-relevant concentrations of sunitinib reduces significantly iROS, MDA and LTB4 compared to only sunitinib-treated cells (P<0.001). In renal cancer cells and cardiomyocytes polydatin reduces expression of pro-inflammatory cytokines and chemokines involved in myocardial damages and chemoresistance and down-regulates the signaling pathway of NLRP3 inflammasome, MyD88 and NF-κB. Data of the present study, although in vitro, indicate that polydatin, besides reducing oxidative stress, reduces key chemokines involved in cancer cell survival, chemoresistance and cardiac damages of sunitinib through downregulation of NLRP3-MyD88 pathway, applying as a potential nutraceutical agent in preclinical studies of preventive cardio-oncology.
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Affiliation(s)
- Vincenzo Quagliariello
- Division of Cardiology, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Simona Buccolo
- Division of Cardiology, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - Martina Iovine
- Division of Cardiology, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - Andrea Paccone
- Division of Cardiology, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Rosaria Taibi
- Department of Pharmacological Sciences, Gruppo Oncologico Ricercatori Italiani, GORI, Pordenone, Italy
| | - Monica Montopoli
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - Nicola Maurea
- Division of Cardiology, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Napoli, Italy
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Shirotake S, Umezawa Y, Okabe T, Kaneko GO, Kanao K, Nishimoto K, Oyama M. Efficacy of Nivolumab Plus Ipilimumab in a Patient With Renal Cell Carcinoma Concomitant With Cardiac Metastasis: A Case Report. In Vivo 2021; 34:1475-1480. [PMID: 32354949 DOI: 10.21873/invivo.11932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Patients with metastatic renal cell carcinoma (RCC) with cardiac metastasis have had poor outcomes in the era of molecular targeted therapy. There are few reported outcomes for patients with cardiac metastasis of RCC treated with immune checkpoint inhibitors (ICIs). CASE REPORT A 32-year-old female presented with metastatic RCC (unclassified type) with contralateral renal and cardiac metastases, as well as renal hilar lymph node metastases (cT4N2M1). An 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) computed tomographic (CT) scan was useful in diagnosing cardiac metastasis. Nivolumab plus ipilimumab achieved prominent shrinkage of almost all tumors except for one cardiac tumor. FDG-PET/CT scan also revealed the marked attenuation of FDG uptake in each tumor. In addition, a needle biopsy of the remaining primary renal tumor was pathologically observed to have no viable cancer cells. CONCLUSION This successful case suggests that ICIs might provide a better outcome even for patients with cardiac metastasis of RCC, and that FDG-PET/CT scan might be useful for therapeutic assessment, as well as diagnosis.
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Affiliation(s)
- Suguru Shirotake
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yuta Umezawa
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takashi Okabe
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - G O Kaneko
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kent Kanao
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Koshiro Nishimoto
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masafumi Oyama
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
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Abstract
In metastatic renal cell carcinoma (mRCC) patients, cardiac metastases are a rare and often a post-mortem finding. Clinical manifestations of cardiac metastases have a late onset and include pericardial effusions, heart failure and embolic phenomena. Treatment of cardiac metastasis is not yet standardized, and few data are available about the efficacy of TKI on treatment of cardiac metastases in mRCC patients. In this report, we describe the case of a 66-year-old male who presented with mRCC with lung and cardiac metastases treated with cabozantinib, a multikinase inhibitor that was administered in second line after disease progression with sunitinib. To date, there are no data about the safety and efficacy of cabozantinib in mRCC with cardiac metastasis. In a real word analysis, cabozantinib demonstrated to be associated to a modest risk of developing left ventricular heart failure. It is unknown if this risk is higher in mRCC population with cardiac metastases. We report the first evidence of efficacy and safety of cabozantinib in cardiac mRCC patients, probably due to its specific inhibition of several molecular intracellular pathways. Additional molecular and clinical studies are needed before well tolerated and efficacy of cabozantinib treatment for these patients can be fully understood.
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Ansari J, Alhelali S, Albinmousa Z, Farrag A, Ali AM, Abdelgelil M, Alhamad A, Alzahrani G, Ansari A, Glaholm J. Rare Case of Intracardiac Renal Cell Carcinoma Metastasis with Response to Nivolumab: Case Report and Literature Review. Case Rep Oncol 2018; 11:861-870. [PMID: 30687063 PMCID: PMC6341359 DOI: 10.1159/000495459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/13/2018] [Indexed: 12/28/2022] Open
Abstract
Intracardiac metastases in the absence of inferior vena cava involvement is a rare occurrence in patients with metastatic renal cell carcinoma (mRCC). There is limited evidence regarding the efficacy and safety of standard treatment modalities for mRCC patients with intracardiac metastases. Presence of intracardiac metastases is known to indicate poor prognosis and may potentially increase risk of treatment-related complications. Recent advances in RCC management have integrated nivolumab, a programmed death-1 (PD-1) receptor inhibitor, as a preferred treatment option in the second-line setting after failure of prior anti-angiogenic therapy; or in combination with ipilimumab, an anti-Cytotoxic T-lymphocyte antigen-4 antibody as first-line therapy for intermediate to poor risk patients with mRCC. The efficacy and toxicity of nivolumab in patients with mRCC and intracardiac metastases has never been reported previously. We herein present the first reported case of mRCC with intracardiac metastasis and a resultant excellent response to nivolumab treatment and discuss the imaging techniques and treatment options for this rare presentation.
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Affiliation(s)
- Jawaher Ansari
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | | | - Ashraf Farrag
- Clinical Oncology Department, Assiut University, Asyut, Egypt
| | - Arwa M Ali
- Medical Oncology Department, South Egypt Cancer Institute, Asyut, Egypt
| | - Mai Abdelgelil
- Clinical Oncology Department, Assiut University, Asyut, Egypt
| | - Abdulaziz Alhamad
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Asif Ansari
- Permian Basin Kidney Center, Odessa, Texas, USA
| | - John Glaholm
- Department of Oncology, Royal Marsden Hospital, London, United Kingdom
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Li Y, Xiong Y, Zhang G, Zhang L, Yang W, Yang J, Huang L, Qiao Z, Miao Z, Lin G, Sun Q, Niu T, Chen L, Niu D, Li L, Yang S. Identification of 5-(2,3-Dihydro-1H-indol-5-yl)-7H-pyrrolo[2,3-d]pyrimidin-4-amine Derivatives as a New Class of Receptor-Interacting Protein Kinase 1 (RIPK1) Inhibitors, Which Showed Potent Activity in a Tumor Metastasis Model. J Med Chem 2018; 61:11398-11414. [PMID: 30480444 DOI: 10.1021/acs.jmedchem.8b01652] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yueshan Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Yu Xiong
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | | | - Liting Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | | | - Jiao Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Luyi Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Zeen Qiao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Zhuang Miao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Guifeng Lin
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Qiu Sun
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | | | - Lijuan Chen
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | - Dawen Niu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
| | | | - Shengyong Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University/Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China
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